Flexible and comformable embolic filtering devices

ABSTRACT

A self-expanding cage for use in conjunction with an embolic filtering device includes one or more circumferential members adapted to expand from an unexpanded position to a expanded position within the patient&#39;s body vessel. At least one proximal strut and at least one distal strut are attached to the circumferential member to form the basket. The circumferential member may include a plurality of bending regions which enhance the ability of the circumferential member to move between the unexpanded and expanded positions. The proximal and distal struts can be attached to one of the bending regions. When two or more circumferential members are utilized, each member may be connected by a connecting strut which may be connected at a bending region. The connecting strut can be a straight segment or may have a non-linear shape to provide additional flexibility. The expandable cage can be mounted to a elongated member, such as a guide wire, and can be either permanently mounted or rotatably mounted thereto.

FIELD OF THE INVENTION

The present invention relates generally to filtering devices used whenan interventional procedure is being performed in a stenosed or occludedregion of a body vessel to capture embolic material that may be createdand released into the vessel during the procedure. The present inventionis more particularly directed to an embolic filtering device made withan expandable cage possessing good flexibility and bendability, whichallows the embolic filtering device to be readily deployed in a bend ina body lumen of a patient.

BACKGROUND OF THE INVENTION

Numerous procedures have been developed for treating occluded bloodvessels to allow blood to flow without obstruction. Such proceduresusually involve the percutaneous introduction of an interventionaldevice into the lumen of the artery, usually by a catheter. One widelyknown and medically accepted procedure is balloon angioplasty in whichan inflatable balloon is introduced within the stenosed region of theblood vessel to dilate the occluded vessel. The balloon dilatationcatheter is initially inserted into the patient's arterial system and isadvanced and manipulated into the area of stenosis in the artery. Theballoon is inflated to compress the plaque and press the vessel wallradially outward to increase the diameter of the blood vessel, resultingin increased blood flow. The balloon is then deflated to a small profileso that the dilatation catheter can be withdrawn from the patient'svasculature and the blood flow resumed through the dilated artery. Asshould be appreciated by those skilled in the art, while theabove-described procedure is typical, it is not the only method used inangioplasty.

Another procedure is laser angioplasty which utilizes a laser to ablatethe stenosis by super heating and vaporizing the deposited plaque.Atherectomy is yet another method of treating a stenosed body vessel inwhich cutting blades are rotated to shave the deposited plaque from thearterial wall. A vacuum catheter is usually used to capture the shavedplaque or thrombus from the blood stream during this procedure.

In the procedures of the kind referenced above, abrupt reclosure mayoccur or restenosis of the artery may develop over time, which mayrequire another angioplasty procedure, a surgical bypass operation, orsome other method of repairing or strengthening the area. To reduce thelikelihood of the occurrence of abrupt reclosure and to strengthen thearea, a physician can implant an intravascular prosthesis formaintaining vascular patency, commonly known as a stent, inside theartery across the lesion. The stent can be crimped tightly onto theballoon portion of the catheter and transported in its delivery diameterthrough the patient's vasculature. At the deployment site, the stent isexpanded to a larger diameter, often by inflating the balloon portion ofthe catheter.

The above non-surgical interventional procedures, when successful, avoidthe necessity of major surgical operations. However, there is one commonproblem which can become associated with all of these non-surgicalprocedures, namely, the potential release of embolic debris into thebloodstream that can occlude distal vasculature and cause significanthealth problems to the patient. For example, during deployment of astent, it is possible that the metal struts of the stent can cut intothe stenosis and shear off pieces of plaque that can travel downstreamand lodge somewhere in the patient's vascular system. Pieces of plaquematerial are sometimes generated during a balloon angioplasty procedureand become released into the bloodstream. Additionally, while completevaporization of plaque is the intended goal during laser angioplasty,sometimes particles are not fully vaporized and enter the bloodstream.Likewise, not all of the emboli created during an atherectomy proceduremay be drawn into the vacuum catheter and, as a result, enter thebloodstream as well.

When any of the above-described procedures are performed in the carotidarteries, the release of emboli into the circulatory system can beextremely dangerous and sometimes fatal to the patient. Debris carriedby the bloodstream to distal vessels of the brain can cause cerebralvessels to occlude, resulting in a stroke, and in some cases, death.Therefore, although cerebral percutaneous transluminal angioplasty hasbeen performed in the past, the number of procedures performed has beensomewhat limited due to the justifiable fear of an embolic strokeoccurring should embolic debris enter the bloodstream and block vitaldownstream blood passages.

Medical devices have been developed to attempt to deal with the problemcreated when debris or fragments enter the circulatory system followingvessel treatment utilizing any one of the above-identified procedures.One approach which has been attempted is the cutting of any debris intominute sizes which pose little chance of becoming occluded in majorvessels within the patient's vasculature. However, it is often difficultto control the size of the fragments which are formed, and the potentialrisk of vessel occlusion still exists, making such a procedure in thecarotid arteries a high-risk proposition.

Other techniques include the use of catheters with a vacuum source whichprovides temporary suction to remove embolic debris from thebloodstream. However, as mentioned above, there can be complicationsassociated with such systems if the vacuum catheter does not remove allof the embolic material from the bloodstream. Also, a powerful suctioncould cause trauma to the patient's vasculature.

Another technique which has had some success utilizes a filter or trapdownstream from the treatment site to capture embolic debris before itreaches the smaller blood vessels downstream. The placement of a filterin the patient's vasculature during treatment of the vascular lesion canreduce the presence of the embolic debris in the bloodstream. Suchembolic filters are usually delivered in a collapsed position throughthe patient's vasculature and then expanded to trap the embolic debris.Some of these embolic filters are self expanding and utilize arestraining sheath which maintains the expandable filter in a collapsedposition until it is ready to be expanded within the patient'svasculature. The physician can retract the proximal end of therestraining sheath to expose the expandable filter, causing the filterto expand at the desired location. Once the procedure is completed, thefilter can be collapsed, and the filter (with the trapped embolicdebris) can then be removed from the vessel. While a filter can beeffective in capturing embolic material, the filter still needs to becollapsed and removed from the vessel. During this step, there is apossibility that trapped embolic debris can backflow through the inletopening of the filter and enter the bloodstream as the filtering systemis being collapsed and removed from the patient. Therefore, it isimportant that any captured embolic debris remain trapped within thisfilter so that particles are not released back into the body vessel.

Some prior art expandable filters vessel are attached to the distal endof a guide wire or guide wire-like member which allows the filteringdevice to be steered in the patient's vasculature as the guide wire ispositioned by the physician. Once the guide wire is in proper positionin the vasculature, the embolic filter can be deployed to captureembolic debris. The guide wire can then be used by the physician todeliver interventional devices, such as a balloon angioplasty dilatationcatheter or a stent delivery catheter, to perform the interventionalprocedure in the area of treatment. After the procedure is completed, arecovery sheath can be delivered over the guide wire using over-the-wiretechniques to collapse the expanded filter for removal from thepatient's vasculature.

When a combination of an expandable filter and guide wire is utilized,it is important that the expandable filter portion remains flexible inorder to negotiate the often tortuous anatomy through which it is beingdelivered. An expandable filter which is too stiff could prevent thedevice from reaching the desired deployment position within thepatient's vasculature. As a result, there is a need to increase theflexibility of the expandable filter without compromising its structuralintegrity once in position within the patient's body vessel. Also, whileit is beneficial if the area of treatment is located in a substantiallystraight portion of the patient's vasculature, sometimes the area oftreatment is at a curved portion of the body vessel which can beproblematic to the physician when implanting the expandable filter. Ifthe expandable filter portion is too stiff, it is possible that thefilter may not fully deploy within the curved portion of the bodyvessel. As a result, gaps between the filter and vessel wall can beformed which may permit some embolic debris to pass therethrough.Therefore, the filtering device should be sufficiently flexible to bedeployed in, and to conform to, a tortuous section of the patient'svasculature, when needed.

Expandable filters can be provided with some increased flexibility byforming the struts of the filter assembly from relatively thin material.However, the use of thin material often can reduce the radiopacity ofthe expandable filter, often making it difficult for the physician tosee the filter under fluoroscopy during deployment. Conversely, the useof thicker materials, which can promote radiopacity of the expandablefilter, usually reduces its flexibility, which may impair thedeliverability of the expandable filter within the patient.

What has been needed is an expandable filter assembly having highflexibility and bendability with sufficient strength and radiopacity tobe successfully deployed within a patient's vasculature to collectembolic debris which may be released into the patient's vasculature.

SUMMARY OF THE INVENTION

The present invention provides a highly flexible cage (also referred toas a “basket”) for use with an embolic filtering device designed tocapture embolic debris created during the performance of a therapeuticinterventional procedure, such as a balloon angioplasty or stentingprocedure, in a body vessel. The present invention provides thephysician with an embolic filtering device having high flexibility to besteered through tortuous anatomy, but yet possessing sufficient strengthto hold open a filtering element against the wall of the body vessel forcapturing embolic debris. An embolic filtering device made in accordancewith the present invention is relatively easy to deploy, has goodvisibility under fluoroscopy, and has good flexibility and isconformable to the patient's anatomy.

An expandable cage made in accordance with the present invention from aself-expanding material, for example, nickel titanium (NiTi) or springsteel, and includes a number of outwardly extending struts capable ofexpanding from a collapsed position having a first delivery diameter toan expanded or deployed position having a second implanted diameter. Afilter element made from an embolic-capturing material is attached tothe expandable cage to move between a collapsed position and a deployedposition.

The struts of the cage can be set to remain in the expanded, deployedposition until an external force is placed over the struts to collapseand move the struts to the collapsed position. One way of accomplishingthis is through the use of a restraining sheath, for example, which canbe placed over the filtering device in a coaxial fashion to contact thecage and move the cage into the collapsed position. The embolicfiltering device can be placed in the patient's vasculature and remainthere for a period of time. The filtering device can be attached to thedistal end of an elongated member, such as a guide wire, for temporaryplacement in the vasculature to capture emboli created during aninterventional procedure. A guide wire may be used in conjunction withthe filtering device when embolic debris is to be filtered during aninterventional procedure. In this manner, the guide wire and filteringassembly, with the restraining sheath placed over the filter assembly,can be placed into the patient's vasculature. Once the physicianproperly manipulates the guide wire into the target area, therestraining sheath can be retracted to deploy the basket into theexpanded position. This can be easily performed by the physician bysimply retracting the proximal end of the restraining sheath (locatedoutside of the patient). Once the restraining sheath is retracted, theself-expanding properties of the cage cause each strut to move in aoutward, radial fashion away from the guide wire to contact the wall ofthe body vessel. As the struts expand radially, so does the filterelement which will now be maintained in place to collect embolic debristhat may be released into the bloodstream as the physician performs theinterventional procedure. The guide wire can then be used by thephysician to deliver the necessary interventional device into the areaof treatment. The deployed filter element captures embolic debriscreated and released into the body vessel during the interventionalprocedure.

In one aspect of the present invention, the enhanced flexibility andbendability of the embolic filtering device is achieved through theutilization of a unique cage design having a highly flexible andconformable circumferential member which is adapted to expand andconform to the size and shape of the body vessel. The expandable cagefurther includes at least one proximal strut having an end connected toa guide wire and the other end attached to the circumferential member.At least one distal strut is attached to the circumferential member andhas its other end attached to the guide wire. The filter element isattached to the circumferential member and will open and close as theexpandable cage moves between its expanded, deployed position and itsunexpanded, delivery position. The circumferential member isself-expanding and is made from a highly flexible material which allowsit to conform to the particular size and shape of the body vessel. Thishigh flexibility and conformability of the circumferential member allowsit to deployed in curved sections of the patient's anatomy and othereccentric vessel locations having non-circular shaped lumens. Thisallows an embolic filtering device made in accordance with the presentinvention to be deployed in locations in the patient's anatomy whichmight not be otherwise suitable for stiffer filtering devices. Moreover,due to the high flexibility and conformability of the circumferentialmember, an embolic filtering device made in accordance with presentinvention is less likely to create gaps between the filtering elementand the wall of the vessel once deployed in the lumen. Therefore, thepotential release of embolic debris past the deployed filter can bereduced.

In another aspect of the present invention, bending regions formed onthe circumferential member help to actuate the circumferential memberbetween its unexpanded and expanded positions. In one aspect of thepresent invention, these bending regions are substantially U-shapedbends formed on the circumferential member at various locations alongthe member. While the circumferential member itself is self-expandingand capable of moving between these positions, the bending regionsfurther enhance the actuation of the circumferential member betweenthese positions. In one particular aspect of the present invention, theproximal strut is attached directly to this bending region. Likewise, adistal strut can be attached to a second bend section. In this fashion,a highly bendable and conformable cage can be produced which shouldconform to the particular shape of the body vessel once deployed.

In other aspects of the present invention, a pair of circumferentialmembers can be utilized to create the expandable cage which maintains ahigh degree of bendability and conformability, but yet is sufficientlyrigid enough to maintain the filtering element in an expanded positiononce the filtering device is fully deployed. Still other aspects of thepresent invention utilize a pair of proximal struts and a pair of distalstruts to form a larger expandable cage which still retains goodbendability and conformability, yet possesses sufficiently radialstrength when deployed to maintain proper wall apposition between thefilter element and the body vessel.

It is to be understood that the present invention is not limited by theembodiments described herein. The present invention can be used inarteries, veins, and other body vessels. Other features and advantagesof the present invention will become more apparent from the followingdetailed description of the invention, when taken in conjunction withthe accompanying exemplary drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view of an embolic filtering device embodyingfeatures of the present invention.

FIG. 2 is a perspective view of the expandable cage which forms part ofthe embolic filtering device of FIG. 1.

FIG. 3 is an elevational view, partially in cross section, of an embolicfiltering device embodying features of the present invention as it isbeing delivered within a body vessel downstream from an area to betreated.

FIG. 4 is an elevational view, partially in cross section, similar tothat shown in FIG. 3, wherein the embolic filtering device is deployedin its expanded position within the body vessel.

FIG. 5 is a perspective view of an alternative embodiment of anexpandable cage similar to the cage of FIG. 2 which is attached to aguide wire that extends through the expandable cage to the distal end ofthe cage.

FIG. 6 is another particular embodiment of an embolic filtering deviceembodying features of the present invention.

FIG. 7 is an side elevational view of the expandable cage which formspart of the embolic filtering device shown in FIG. 6.

FIG. 8 is a top plan view of the expandable cage of FIG. 7 taken alongline 8-8.

FIG. 9 is an end view of the expandable cage of FIG. 7 taken along line9-9.

FIG. 10 is an alternative embodiment of an embolic filtering deviceembodying features of the present invention which utilizes a similarexpandable cage as shown in FIG. 5.

FIG. 11 is an elevational view, partially in cross-section, of thedistal end of the embolic filtering device of FIG. 1.

FIG. 12 is an elevational view, partially in cross-section, of thedistal end of the embolic filtering device of FIG. 10.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

Turning now to the drawings, in which like reference numerals representlike or corresponding elements in the drawings, FIGS. 1 and 2 illustrateone particular embodiment of an embolic filtering device 20incorporating features of the present invention. This embolic filteringdevice 20 is designed to capture embolic debris which may be created andreleased into a body vessel during an interventional procedure. Theembolic filtering device 20 includes an expandable filter assembly 22having a self-expanding basket or cage 24 and a filter element 26attached thereto. In this particular embodiment, the expandable filterassembly 22 is rotatably mounted on the distal end of an elongated(solid or hollow) cylindrical tubular shaft, such as a guide wire 28.The guide wire has a proximal end (not shown) which extends outside thepatient and is manipulated by the physician to deliver the filterassembly into the target area in the patient's vasculature. Arestraining or delivery sheath 30 (FIG. 3) extends coaxially along theguide wire 28 in order to maintain the expandable filter assembly 22 inits collapsed position until it is ready to be deployed within thepatient's vasculature. The expandable filter assembly 22 is deployed bythe physician by simply retracting the restraining sheath 30 proximallyto expose the expandable filter assembly. Once the restraining sheath isretracted, the self-expanding cage 24 immediately begins to expandwithin the body vessel (see FIG. 4), causing the filter element 26 toexpand as well.

An obturator 32 affixed to the distal end of the filter assembly 32 canbe implemented to prevent possible “snowplowing” of the embolicfiltering device as it is being delivered through the vasculature. Theobturator can be made from a soft polymeric material, such as Pebax 40D,and has a smooth surface to help the embolic filtering device travelthrough the vasculature and cross lesions while preventing the distalend of the restraining sheath 30 from “digging” or “snowplowing” intothe wall of the body vessel.

In FIGS. 3 and 4, the embolic filtering device 20 is shown as it isbeing delivered within an artery 34 or other body vessel of the patient.Since the embolic filtering device made in accordance with the presentinvention possesses excellent bendability and flexibility, it willconform well to the shape of the vasculature while allowing the filterassembly to more easily negotiate a curved radius in the patient'svasculature.

Referring now to FIG. 4, the embolic filtering device 22 is shown in itsexpanded position within the patient's artery 34. This portion of theartery 34 has an area of treatment 36 in which atherosclerotic plaque 38has built up against the inside wall 40 of the artery 34. The filterassembly 22 is to be placed distal to, and downstream from, the area oftreatment 36. For example, the therapeutic interventional procedure maycomprise the implantation of a stent (not shown) to increase thediameter of an occluded artery and increase the flow of bloodtherethrough. It should be appreciated that the embodiments of theembolic filtering device described herein are illustrated and describedby way of example only and not by way of limitation. Also, while thepresent invention is described in detail as applied to an artery of thepatient, those skilled in the art will appreciate that it can also beused in other body vessels, such as the coronary arteries, carotidarteries, renal arteries, saphenous vein grafts and other peripheralarteries. Additionally, the present invention can be utilized when aphysician performs any one of a number of interventional procedures,such as balloon angioplasty, laser angioplasty or atherectomy whichgenerally require an embolic filtering device to capture embolic debriscreated during the procedure.

The cage 24 includes self-expanding struts which, upon release from therestraining sheath 30, expand the filter element 26 into its deployedposition within the artery (FIG. 4). Embolic particles 27 created duringthe interventional procedure and released into the bloodstream arecaptured within the deployed filter element 26. The filter may includeperfusion openings 29, or other suitable perfusion means, for allowingblood flow through the filter 26. The filter element will captureembolic particles which are larger than the perfusion openings whileallowing some blood to perfuse downstream to vital organs. Although notshown, a balloon angioplasty catheter can be initially introduced withinthe patient's vasculature in a conventional SELDINGER technique througha guiding catheter (not shown). The guide wire 28 is disposed throughthe area of treatment and the dilatation catheter can be advanced overthe guide wire 28 within the artery 34 until the balloon portion isdirectly in the area of treatment 36. The balloon of the dilatationcatheter can be expanded, expanding the plaque 38 against the wall 40 ofthe artery 34 to expand the artery and reduce the blockage in the vesselat the position of the plaque 38. After the dilatation catheter isremoved from the patient's vasculature, a stent (not shown) could beimplanted in the area of treatment 36 using over-the-wire techniques tohelp hold and maintain this portion of the artery 34 and help preventrestenosis from occurring in the area of treatment. The stent could bedelivered to the area of treatment on a stent delivery catheter (notshown) which is advanced from the proximal end of the guide wire to thearea of treatment. Any embolic debris created during the interventionalprocedure will be released into the bloodstream and should enter thefilter 26. Once the procedure is completed, the interventional devicemay be removed from the guide wire. The filter assembly 22 can also becollapsed and removed from the artery 34, taking with it any embolicdebris trapped within the filter element 26. A recovery sheath (notshown) can be delivered over the guide wire 28 to collapse the filterassembly 22 for removal from the patient's vasculature.

Referring again to FIGS. 1 and 2, the expandable cage 24 includes a pairof self-expanding proximal struts 42 and 44 which help to deploy thefilter element 26 and the remainder of the expandable cage. Theseproximal struts 42 and 44 are coupled to a first circumferential member46 which is adapted to move from the unexpanded delivery position (FIG.3) to the expanded deployed position (FIG. 4). A second circumferentialmember 48 is, in turn, coupled to the first circumferential member 46.The deployment of the first and second circumferential members 46 and 48results in the filter element 26 being placed against the wall 40 of theartery or other body vessel, even if the lumen of the body vessel isnon-circular. A pair of distal struts 50 and 52 connected to the secondcircumferential member 48 extend distally towards the obturator 32. Thefirst and second circumferential members 46 and 48 are coupled to, andspaced apart, from each other by short connecting struts 54. It shouldbe appreciated that a single circumferential member could be used tocreate an expandable cage made in accordance with the present invention.Also, additional circumferential members could be added to create alarger expandable cage. Additionally, while only two proximal struts anddistal struts are shown in the cage design of FIGS. 1-5, the cage couldalso be made with a single proximal and distal strut (see FIGS. 6-10) oradditional struts (not shown) could be implemented without departingfrom the spirit and scope of the present invention.

As can be seen in FIGS. 1 and 2, each circumferential member includesfour bending regions 56, 58, 60 and 62 formed on the circumferentialmember to enhance the performance of the circumferential member to bendas it moves between the unexpanded and expanded positions. In theparticular embodiment shown in FIG. 2, each bending region 56-62 isplaced on the circumferential member approximately 90 degrees apart.Each of the proximal struts includes a first end 64 attached to thecollar 65 which is rotatably mounted to the guide wire 28. Each proximalstrut includes a second end 66 connected to one of the proximal bendingregions 56 and 58 of the first circumferential member 46. These proximalbending regions 56 and 58 are spaced approximately 180 degrees apartfrom each other along a circular diameter defined by the expandedcircumferential member 46. Each of the distal struts 50 and 52, in turn,has a first end 68 connected to and extending towards the obturator 32and a second end 70 attached to the distal bending regions 60 and 62 ofthe second circumferential member 48. These distal bending regions 60and 62, in turn, are spaced approximately 180 degrees apart from eachother and are offset 90 degrees from the proximal bending regions 56 and58.

Each of the bending regions is substantially U-shaped which help tocreate a natural bending point on the circumferential member. While theflexibility of the circumferential members is already high, thesebending regions only help to increase the ability of the circumferentialmember to collapse or expand when needed. In this manner, the shape ofthe hinge regions creates a natural hinge that helps to actuate theexpandable cage between the unexpanded and expanded positions. As can bebest seen in FIG. 2, the U-shaped bending regions 54 and 56 arepositioned directly opposite the U-shaped portion of the distal bendingregions 58 and 60. The positioning of the direction of the U portionalso enhances the ability of the circumferential member to bend. Thesecircumferential members 46 and 48, while being quite bendable,nevertheless maintain sufficient radial strength to remain in thedeployed position to hold the filter element 26 open in the body vesselfor collecting embolic particles which may be entrained in the bodyfluid.

The shape of the bending regions are shown as substantially U-shapedportions, however, any one of a number of different shapes could also beutilized to create a natural bending point on the circumferentialmember. For example, a V-shaped region could also be formed and wouldfunction similarly to a U-shaped portion to facilitate the collapse andexpansion of the circumferential member as needed. Alternative shapesand sizes of the bending regions also could be utilized withoutdeparting from the spirit and scope of the invention. Although fourbending regions are shown on each circumferential member, it should beappreciated that the number of different bending regions could beincreased or decreased as needed. For example, it is possible to utilizeonly two bending regions, as is shown in the embodiment of theexpandable cage of FIG. 6, in order to facilitate bending. Additionalbending regions also could be utilized in the event that additionalproximal or distal struts are used to form the expandable cage.Moreover, different sizes, shapes and location of the bending regionscan be utilized on any circumferential member.

The expandable cage 24 of FIGS. 1 and 2 is shown rotatably mounted tothe distal end of the guide wire 28 to allow the entire filteringassembly 22 to remain stationary once deployed in the body vessel. Thisfeature prevents the filtering assembly from rotating in the event thatthe proximal end of the guide wire is accidentally rotated by thephysician during use. As a result, the possibility that the deployedfiltering assembly 22 could be rotated to cause trauma to the wall ofthe vessel is minimized. Referring specifically to FIGS. 1 and 2, thefirst end 64 of the proximal struts 42 and 44 are attached to the collar65 which is rotatably mounted on the guide wire 28 between a pair ofstop fittings 72 and 74. The stop fittings 72 and 74 allow theexpandable cage 24 to spin on the guide wire but restricts thelongitudinal movement of the cage on the guide wire. This particularmechanism is but one way to rotatably mount the expandable cage 24 tothe guide wire 28.

The expandable cage is shown in FIGS. 1 and 2 does not include a segmentof guide wire which would otherwise extend through the expandable cage24 to the distal end where the coil tip 76 extends through the obturator32. In this manner, the elimination of this short segment of guide wirethrough the expandable cage 24 may help collapse the filter assembly 22to a smaller delivery profile. The lack of the guide wire segment alsomay help to increase the flexibility and bendability of the filteringassembly 22 somewhat as it is being delivered through the patient'svasculature.

Referring now to FIG. 5, an alternative version of the embolic filteringdevice 20 is shown as it is rotatably mounted onto a guide wire 28. InFIG. 5, the filter element has been removed to better show the portionof the guide wire which extends through the expandable cage to the coiltip of the guide wire. In this particular embodiment, a short segment ofguide wire 78 is present and extends through the expandable cage 24 andextends through the obturator 32. This particular embodiment of theembolic filtering device functions in the same fashion as the filterdevice shown and described in FIGS. 1-4. However, a full-length guidewire is utilized in conjunction with this particular embodiment. Whilethis particular embodiment of the filtering device may not be collapsedto a smaller profile as the one shown in FIGS. 1 and 2, nevertheless ithas the advantage of a full-length guide wire which allows the physicianto manipulate the proximal end of the guide wire in order to steer thedevice in the patient's vasculature. The expandable cage 24 would berotatably mounted on the guide wire as the proximal collar would beplaced between two stop fittings located on the guide wire. One benefitfrom this particular embodiment stems from the ability of the physicianto control the proximal end of the guide wire in order to steer thedistal coil tip 76 into the desired vessel when delivering the devicethrough the patient's vasculature. The embodiment of the filteringdevice shown in FIG. 1, while having its own advantages, does not allowthe guide wire itself to be rotated at its proximal end of the guidewire to steer the distal coil tip 76 of the guide wire. However, thecomposite delivery sheath utilized to restrain and maintain theexpandable filter in its collapsed position during delivery could berotated by the physician to steer the coil tip into the desired vessel.In this manner, the proximal end of the delivery sheath could be torquedby the physician to rotate the distal coil wire into the targetlocation. Alternatively, the particular design shown in FIG. 1 couldalso be modified so that the distal end of the guide wire, rather thanbeing rotatably connected to the cage 24, is permanently attachedtogether. In such a modification, the first ends of the proximal struts42 and 44 could be simply bonded or otherwise fastened directly to theguide wire such that the expandable cage will rotate as the guide wireis being rotated. This particular embedment would allow the physician tosimply torque the proximal end of the guide wire to steer the distalcoil into the desired area of treatment.

Referring now to FIG. 11, one manner in which the distal ends 68 of thedistal struts 52 and 50 could be attached to the obturator 32 as shown.As can be seen in FIG. 11, the distal ends 68 are attached to a tubularmember 80 which extends into the obturator 32. The ends 68 are attachedto the outer surface 82 of the tubular member 80. The filter 26 tapersto a distal end 84 which is, in turn, bonded or otherwise adhesivelyattached to the outer surface 82 of this tubular member 80. Likewise, atleast a portion of the tubular member 80 is in contact with theobturator 32 and is adhesively bonded or otherwise affixed thereto. Theinner surface 86 of the tubular member 80 is in turn attached to a shortsegment 88 of the guide wire which extends out to the distal coil tip76. In this manner, the short segment 88 of the guide wire is adhesivelybonded or otherwise attached to the inner surface 68 to remain in place.The combination of elements thus form an integral distal end for thefiltering assembly which will remain intact during usage.

Referring now to FIGS. 6-9, an alternative embodiment of the embolicfilter device 90 is shown which includes an expandable filter assembly92 with an expandable cage 94. In this particular embodiment, theexpandable cage is a modification of the expandable cage 24 shown inFIGS. 1-5. The filter assembly 92 includes the filter member 96 which isutilized to filter the embolic debris in the body vessel and includes aplurality of openings 98 through which the body fluid flows throughwhile the embolic particles remain trapped in the pocket formed by thefilter member 96. The filter assembly 92 is also shown attached to aguide wire 100 which has a proximal end (not shown) which extendsoutside of the patient's body and is manipulated by the physician inorder to steer the device into the target area in the patient'svasculature. This particular embodiment 90 is self-expanding, as theother embodiment shown in FIGS. 1-5, and would be kept in a collapseddelivery position through the use of a sheath which would extend overthe filter assembly (as is shown in FIG. 3) in order to deliver thedevice into the target area.

The expandable cage 94 includes a pair of circumferential members 102and 104 which are connected together by connecting struts 106. Thisparticular embodiment utilizes a single proximal strut 108 and a singledistal strut which extends from the second circumferential member 104 tothe obturator 112. A distal coil tip 114 extends distally from theobturator 112 and is utilized by the physician to steer the device intothe desired body lumen.

The circumferential members 102 and 104 of this particular expandablecage 94 includes only a pair of bending regions 114 and 116 although itis still possible to utilize other bending regions along thecircumferential member if desired. As a result, the use of a singleproximal strut 108 minimizes the surface area of struts placed in frontof the opening of the filter assembly 92 thus minimizing the chancesthat emboli could collect on strut areas rather than being forced intothe filter member 96. The use of a single distal strut also allows thedevice to be more flexible in the distal area where flexibility isneeded when negotiating tortuous anatomy. It should be appreciated thata single circumferential member could be used in accordance with thepresent embodiment or additional circumferential members could beutilized to create a longer filtering assembly if desired.

The proximal strut 108 includes one end 118 which is attached to acollar 120 that is rotatably mounted onto the distal end of the guidewire 100. A pair of stop fittings 122 and 124 maintain the collar 120rotatably mounted to the distal end of the guide wire 100. The other end126 of the proximal strut 108 is in turn attached to the bending region114 located on the proximal circumferential member 102. The distal strut110 includes one end 128 which is attached to the bending region 116 ofthe second circumferential member 104 with the other end 130 attached tothe obturator 112. FIG. 12 shows one particular method for attaching thedistal end 130 to the obturator 112. The method of attachment is verysimilar to the attachment arrangement shown in FIG. 11 in that thedistal end 130 is attached to a tubular member 132 having an outsidesurface 134 and an inner surface 136. A short segment 138 of the guidewire which is attached to the distal coil tip 114 can be adhesivelysecured or otherwise fastened to the inner surface 136 of the tubularmember 132. Likewise, the distal end 130 of the strut 110 is adhesivelybonded or otherwise secured to the outer surface 134 of the tubularmember 132. The filter member 96 terminates at a distal end 140 whichcan be bonded both to the outer surface 134 of the tubular member 132and also to the inner surface of the obturator 112. In this manner, thedistal end of the assembly will remain securedly fastened to form anintegral unit that will remain intact during usage.

Referring now to FIG. 10, an alternative design to the embodiment ofFIGS. 6-9 is shown in which a short segment 142 of the guide wireextends through the opening of the expandable cage 94 and extends to thedistal end where the distal coil tip 114 is located. In this particularembodiment of the embolic filtering device 90, the short segment 142 ofthe guide wire extends through the expandable cage 94 and performssubstantially the same functions as the embodiment shown in FIG. 5. Thetubular member 132 (not shown in FIG. 10) can also extend into theexpandable cage 94 to help prevent the filter 96 from tangling on theguide wire segment 142 when the cage 94 is collapsed. The use of a guidewire which extends to the distal most end of the device provides goodtorqueability to the physician when maneuvering the device in thepatient's vasculature. It should also be noted that the expandable cage94 shown in FIGS. 6-9 could also be permanently affixed to the distalend of the guide wire, rather than being rotatably mounted thereto.

The expandable cage of the present invention can be made in many ways.One particular method of making the cage is to cut a thin-walled tubularmember, such as nickel-titanium hypotube, to remove portions of thetubing in the desired pattern for each strut, leaving relativelyuntouched the portions of the tubing which are to form each strut. Thetubing may be cut into the desired pattern by means of amachine-controlled laser. The tubing used to make the cage couldpossible be made of suitable biocompatible material such as springsteel. Elgiloy is another material which could possibly be used tomanufacture the cage. Also, very elastic polymers possibly could be usedto manufacture the cage.

The strut size is often very small, so the tubing from which the cage ismade may have a small diameter. Typically, the tubing has an outerdiameter on the order of about 0.020-0.040 inches in the unexpandedcondition. Also, the cage can be cut from large diameter tubing.Fittings are attached to both ends of the lased tube to form the finalcage geometry. The wall thickness of the tubing is usually about 0.076mm (0.001-0.006 inches). As can be appreciated, the strut width and/ordepth at the bending points will be less. For cages deployed in bodylumens, such as PTA applications, the dimensions of the tubing may becorrespondingly larger. While it is preferred that the cage be made fromlaser cut tubing, those skilled in the art will realize that the cagecan be laser cut from a flat sheet and then rolled up in a cylindricalconfiguration with the longitudinal edges welded to form a cylindricalmember.

Generally, the tubing is put in a rotatable collet fixture of amachine-controlled apparatus for positioning the tubing relative to alaser. According to machine-encoded instructions, the tubing is thenrotated and moved longitudinally relative to the laser which is alsomachine-controlled. The laser selectively removes the material from thetubing by ablation and a pattern is cut into the tube. The tube istherefore cut into the discrete pattern of the finished struts. The cagecan be laser cut much like a stent is laser cut. Details on how thetubing can be cut by a laser are found in U.S. Pat. No. 5,759,192(Saunders), U.S. Pat. No. 5,780,807 (Saunders) and U.S. Pat. No.6,131,266 (Saunders) which have been assigned to Advanced CardiovascularSystems, Inc.

The process of cutting a pattern for the strut assembly into the tubinggenerally is automated except for loading and unloading the length oftubing. For example, a pattern can be cut in tubing using a CNC-opposingcollet fixture for axial rotation of the length of tubing, inconjunction with CNC X/Y table to move the length of tubing axiallyrelative to a machine-controlled laser as described. The entire spacebetween collets can be patterned using the CO₂ or Nd:YAG laser set-up.The program for control of the apparatus is dependent on the particularconfiguration used and the pattern to be ablated in the coding.

A suitable composition of nickel-titanium which can be used tomanufacture the strut assembly of the present invention is approximately55% nickel and 45% titanium (by weight) with trace amounts of otherelements making up about 0.5% of the composition. The austenitetransformation temperature is between about 0° C. and 20° C. in order toachieve superelasticity at human body temperature. The austenitetemperature is measured by the bend and free recovery tangent method.The upper plateau strength is about a minimum of 60,000 psi with anultimate tensile strength of a minimum of about 155,000 psi. Thepermanent set (after applying 8% strain and unloading), is less thanapproximately 0.5%. The breaking elongation is a minimum of 10%. Itshould be appreciated that other compositions of nickel-titanium can beutilized, as can other self-expanding alloys, to obtain the samefeatures of a self-expanding cage made in accordance with the presentinvention.

In one example, the cage of the present invention can be laser cut froma tube of nickel-titanium (Nitinol) whose transformation temperature isbelow body temperature. After the strut pattern is cut into thehypotube, the tubing is expanded and heat treated to be stable at thedesired final diameter. The heat treatment also controls thetransformation temperature of the cage such that it is super elastic atbody temperature. The transformation temperature is at or below bodytemperature so that the cage is superelastic at body temperature. Thecage is usually implanted into the target vessel which is smaller thanthe diameter of the cage in the expanded position so that the struts ofthe cage apply a force to the vessel wall to maintain the cage in itsexpanded position. It should be appreciated that the cage can be madefrom either superelastic, stress-induced martensite NiTi or shape-memoryNiTi.

The cage could also be manufactured by laser cutting a large diametertubing of nickel-titanium which would create the cage in its expandedposition. Thereafter, the formed cage could be placed in its unexpandedposition by backloading the cage into a restraining sheath which willkeep the device in the unexpanded position until it is ready for use. Ifthe cage is formed in this manner, there would be no need to heat treatthe tubing to achieve the final desired diameter. This process offorming the cage could be implemented when using superelastic orlinear-elastic nickel-titanium.

The struts forming the proximal struts can be made from the same or adifferent material than the distal struts. In this manner, more or lessflexibility for the proximal struts can be obtained. When a differentmaterial is utilized for the struts of the proximal struts, the distalstruts can be manufactured through the lazing process described abovewith the proximal struts being formed separately and attached. Suitablefastening means such as adhesive bonding, brazing, soldering, weldingand the like can be utilized in order to connect the struts to thedistal assembly. Suitable materials for the struts include superelasticmaterials, such as nickel-titanium, spring steel, Elgiloy, along withpolymeric materials which are sufficiently flexible and bendable.

The connecting struts utilized to connect one or more circumferentialmembers together are shown generally as straight segments. However, itis possible to utilize non-linear shapes and sizes which may provideadditional flexibility and bendability within the patient's anatomy.Additionally, it is possible to make these connecting struts out ofmaterials which are different from the rest of the expandable cage tofurther increase flexibility if needed. For example, the connectingstrut could be made in an S-shape which may provide additionalflexibility in certain curved locations in the patient's anatomy.Moreover, the size and width of the strut could be varied from theremaining strut widths and thicknesses in order to promote additionalflexibility. In a similar fashion, the bending regions formed on thecircumferential members could also be formed with thinner and narrowerstrut widths than the remaining elements of the cage in order to enhanceflexibility at these bending regions.

The polymeric material which can be utilized to create the filteringelement include, but is not limited to, polyurethane and Gortex, acommercially available material. Other possible suitable materialsinclude ePTFE. The material can be elastic or non-elastic. The wallthickness of the filtering element can be about 0.00050-0.0050 inches.The wall thickness may vary depending on the particular materialselected. The material can be made into a cone or similarly sized shapeutilizing blow-mold technology or dip technology. The openings can beany different shape or size. A laser, a heated rod or other process canbe utilized to create to perfusion openings in the filter material. Theholes, would of course be properly sized to catch the particular size ofembolic debris of interest. Holes can be lazed in a spinal pattern withsome similar pattern which will aid in the re-wrapping of the mediaduring closure of the device. Additionally, the filter material can havea “set” put in it much like the “set” used in dilatation balloons tomake the filter element re-wrap more easily when placed in the collapsedposition.

The materials which can be utilized for the restraining sheath can bemade from polymeric material such as cross-linked HDPE. This sheath canalternatively be made from a material such as polyolifin which hassufficient strength to hold the compressed strut assembly and hasrelatively low frictional characteristics to minimize any frictionbetween the filtering assembly and the sheath. Friction can be furtherreduced by applying a coat of silicone lubricant, such as Microglide®,to the inside surface of the restraining sheath before the sheaths areplaced over the filtering assembly.

Further modifications and improvements may additionally be made to thedevice and method disclosed herein without departing from the scope ofthe present invention. Accordingly, it is not intended that theinvention be limited, except as by the appended claims.

1. An expandable cage for an embolic filtering device used to captureembolic debris in a body vessel, the cage comprising: a circumferentialmember adapted to move between a collapsed position and an expandedposition, the circumferential member including a plurality of bendingregions formed therein; a proximal strut attached to the circumferentialmember; and a distal strut attached to the circumferential member. 2.The cage of claim 1, wherein the proximal strut and distal strut areattached to the circumferential member at bending regions.
 3. The cageof claim 1, wherein the proximal strut has a free end which is adaptedto be rotatably mounted on an elongated member.
 4. The cage of claim 1,further including a plurality of proximal struts attached to bendingregions located on the circumferential member.
 5. The cage of claim 1,further including a plurality of distal struts attached to bendingregions located on the circumferential member.
 6. The cage of claim 1,further including a second circumferential member attached to the firstmentioned circumferential member, the second circumferential memberincluding a plurality of bending regions formed therein; wherein thedistal strut is attached to the second circumferential member.
 7. Thecage of claim 6, wherein the proximal strut is attached to the firstcircumferential member at a bending region and the distal strut isattached to the second circumferential member at a bending region. 8.The cage of claim 6, wherein the first and second circumferentialmembers are attached to each other by at least one connecting strut. 9.The cage of claim 7, wherein the first and second circumferentialmembers are attached to each other by at least one connecting strut. 10.The cage of claim 8, wherein the connecting strut is attached at bendingregions of the first and second circumferential members.
 11. The cage ofclaim 9, wherein the connecting strut is attached at bending regions ofthe first and second circumferential members.
 12. The cage of claim 8,wherein the connecting strut is made from a different material than theproximal strut and distal strut.
 13. The cage of claim 8, wherein theconnecting strut is independently capable of expanding or contractingwhen subjected to a certain amount of force.
 14. The cage of claim 8,wherein the connecting strut has an S-shape.
 15. The cage of claim 14,wherein the S-shape of the connecting strut is capable of expanding orcontracting when subjected to a certain amount of force.
 16. The cage of claim 6, further including a plurality of proximal struts attached tobending regions located on the first circumferential member.
 17. Thecage of claim 16, further including a plurality of distal strutsattached to bending regions located on the second circumferentialmember.
 18. The cage of claim 1, wherein each bending region is locatedabout 180 degrees apart from the other on the circumferential member.19. The cage of claim 1, wherein each bending region has a substantial Ushape.
 20. The cage of claim 19, wherein each U-shaped bending region isoriented opposite each other.
 21. The cage of claim 6, wherein eachbending region is located about 180 degrees apart from the other on thecircumferential member.
 22. The cage of claim 6, wherein each bendingregion has a substantial U shape.
 23. The cage of claim 22, wherein eachU-shaped bending region is oriented opposite each other.
 24. Anexpandable cage for an embolic filtering device used to capture embolicdebris in a body vessel, the cage comprising: a proximal circumferentialmember adapted to move between a collapsed position and an expandedposition, the proximal circumferential member including a plurality ofbending regions formed therein; a distal circumferential member adaptedto move between a collapsed position and an expanded position, thedistal circumferential member including a plurality of bending regionsformed therein, the proximal circumferential member being connected tothe distal circumferential member; a proximal strut attached to theproximal circumferential member; and a distal strut attached to thedistal circumferential member.
 25. The cage of claim 24, wherein theproximal strut and distal strut are attached to the proximal and distalcircumferential members at bending regions.
 26. The cage of claim 25,further including a plurality of proximal struts attached to bendingregions located on the proximal circumferential member.
 27. The cage ofclaim 26, further including a plurality of distal struts attached tobending regions located on the distal circumferential member.
 28. Thecage of claim 24, further including another circumferential memberattached to and located between the proximal circumferential member andthe distal circumferential member.
 29. The cage of claim 24, wherein theproximal and distal circumferential members are attached to each otherby at least one connecting strut.
 30. The cage of claim 29, furtherincluding a plurality of connecting struts connecting to bending regionsformed on the proximal and distal circumferential members.
 31. The cageof claim 29, wherein the connecting strut is attached at bending regionsof the proximal and distal circumferential members.
 32. The cage ofclaim 29, wherein the connecting strut is made from a different materialthan the proximal strut and distal strut.
 33. The cage of claim 29,wherein the connecting strut is independently capable of expanding orcontracting when subjected to a certain amount of force.
 34. The cage ofclaim 29, wherein the connecting strut has an S-shape.
 35. An expandablecage for an embolic filtering device used to capture embolic debris in abody vessel, the cage comprising: a proximal circumferential memberadapted to move between a collapsed position and an expanded position,the proximal circumferential member including a plurality of bendingregions formed therein; a distal circumferential member adapted to movebetween a collapsed position and an expanded position, the distalcircumferential member including a plurality of bending regions formedtherein, the proximal circumferential member being connected to thedistal circumferential member; a plurality of proximal struts attachedto the proximal circumferential member; and a plurality of distal strutsattached to the distal circumferential member.
 36. The cage of claim 35,wherein each of the proximal struts is attached to a bending region onthe proximal circumferential member and each of the distal struts isattached to a bending region on the distal circumferential member. 37.The cage of claim 35, further including another circumferential memberattached to and located between the proximal circumferential member andthe distal circumferential member.
 38. The cage of claim 35, wherein theproximal and distal circumferential members are attached to each otherby at least one connecting strut.
 39. The cage of claim 35, furtherincluding a plurality of connecting struts which connect the proximalcircumferential member to the distal circumferential member.
 40. Thecage of claim 39, wherein each connecting member is attached at abending region on each of the proximal and distal circumferentialmember. 41-61. (canceled)